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Exploring the impact and experience of fractional work in medicine: a qualitative study of medical oncologists in Australia
  1. Emma Kirby1,
  2. Alex Broom2,
  3. Deme Karikios3,4,
  4. Rosemary Harrup5,
  5. Zarnie Lwin6,7
  1. 1 Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
  2. 2 School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Penrith, New South Wales, Australia
  4. 4 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  5. 5 Department of Medical Oncology/Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
  6. 6 Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  7. 7 School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Dr Emma Kirby; emma.kirby{at}


Objectives Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians’ views on the consequences of fractional work in oncology.

Design Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.

Setting New South Wales, Australia.

Participants Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages.

Results Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care.

Conclusion Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.

  • oncology
  • qualitative research
  • workforce
  • fractional work
  • part time work
  • Australia

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  • Contributors All authors conceived of and designed the study. EK and AB analysed and interpreted the data. EK, AB and ZL drafted the article; all authors contributed to the development and refining of the article, and approved the final submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement statement It was not appropriate or possible to involve patients or the public in this work.

  • Patient consent for publication Not required.

  • Ethics approval This research was performed in accordance with the Declaration of Helsinki. Ethics approval was received from The University of Tasmania Human Research Ethics Committee (Ref: H0014781), and all participants provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.